Definitions: Built Environment The built environment includes our homes, schools, workplaces, parks/recreation areas, business areas and roads. It extends overhead in the form of electric transmission lines, underground in the form of waste disposal sites and subway trains, and across the country in the form of highways. The built environment encompasses all buildings, spaces and products that are created or modified by people. It impacts indoor and outdoor physical environments (e.g., climatic conditions and indoor/outdoor air quality), as well as social environments (e.g., civic participation, community capacity and investment) and subsequently our health and quality of life.

http://www.ajph.org/cgi/content/full/93/9/1446

Text: “Creating Healthy Communities, Healthy Homes, Healthy People: Initiating a Research Agenda on the Built Environment and Public Health ,” Shobha Srinivasan, PhD, Liam R. O’Fallon,

MA and Allen Dearry, PhD September 2003, Vol 93, No. 9 | American Journal of Public

Health 1446-1450 © 2003 American Public Health Association Image: UM & Coral Gables, www.bing.com

Built Environment & Health: History 19th century Industrial revolution &

immigration moves population to cities; unsanitary conditions lead to infectious disease epidemics

20th century Public health policy implemented

through zoning that restricts population density; and separates commerce, industry and residences

21st century Primary public health problems are

chronic diseases rather than infectious diseases, and half of Americans live in suburban rather than urban or rural settings

Image, South Street NYC, Fordham University Text: Wendy Collins Perdue, JD, Lesley A. Stone, JD, and Lawrence O. Gostin, “The Built Environment and Its Relationship to the Public’s Health: The Legal Framework,” American Journal of Public Health ,September 2003, Vol 93, No. 9: 1390-4.

Jordan Rappaport, “The Shared Fortunes of Cities and Suburbs,” Federal Reserve Bank Of Kansas City Economic Review, Third

Quarter 2005. http://www.kc.frb.org/publicat/ECONREV/PDF/3q05rapp.pdf

Median Population Growth by Decade

Highway vs. Mass Transit Expenditures

1. U.S. Congressional Budget Office. Trends in Public Spending on Transportation and Water Infrastructure, 1956 to 2004, August 2007. Data obtained from supplementary tables downloaded from www.cbo.gov/ftpdocs/85xx/doc8517/SupplementalTables.xls, 17 December 2007.

Cumulative Government Capital Investment in Transit & Highways since 1956

Miles per Capita

UMSA talk, Richard Jackson, M.D. 2009

VMT more than doubles in one generation: 4570 in 1965 9220 in 1995

For every age group from 3 through 33,

crashes were the #1 cause of death

UMSA talk, Richard Jackson, M.D. 2009

Mortality

Travel to School

Post World War II Number of Schools

declined 70% Average School Size grew

fivefold, from 127 to 653 students (3)

A survey by the Centers for Disease Control and Prevention (CDC) found that even children living close to school were not walking or biking in large numbers. Children 5-15 living within 1 mile of school 2002- 31% walked or biked. 1969- 90% walked or biked (2)

http://www.epa.gov/dced/pdf/school_travel.pdf

2002 Study- Schools built before 1983:

16% of students walk

Schools built after 1983: 4% of students walk

(4)

Travel And Environmental Implications of School Siting, EPA, EPA231-R-03-004, October 2003

Miami Palmetto Senior High School, 247,765 sq.ft. building/ 23 acres:

3,349 students grades 9-12 http://mpsh.dadeschools.net/overview.htm

Frequency of walking > 20 times per month

0.000.250.500.751.001.251.50

> 1973 1946-1973 < 1946

Age of home

Adj

uste

d od

ds ra

tio

Walking (odds ratio)

Age of Home & Physical Activity Adults who lived in homes built before 1946 and from 1946 to 1973 were significantly more likely to walk 1+ miles ≥20 times per month than those who lived in homes built after 1973. This association was present among people living in urban and suburban counties, but absent among those living in rural counties. The association was also found in models that controlled for gender, race/ethnicity, age, education, income, and any health-related activity limitation. Other forms of leisure-time physical activity were not independently associated with home age.

David Berrigan and Richard P. Troiano, “The association between urban form and physical activity in U.S. adults,” American Journal of Preventive Medicine, Volume 23, Issue 2, Supplement 1, August 2002, Pages 74-79

2007

Behavioral Research Factor Surveillance System, CDC http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm

Obesity (BMI > 30) Trends Among U.S. Adults Behavioral Risk Factor Surveillance System (BRFSS),

1991, 1996, 2003, 2007 & 2008

Behavioral Research Factor Surveillance System, CDC http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm

Mixed-Use & Obesity

Lawrence D. Frank, Martin A. Andresen and Thomas .L. Schmid, “Obesity Relationships with Community

Design, Physical Activity, and Time Spent in Cars,“ American Journal of Preventative Medicine, Vol. 27

(2):2004: 87–96

Probability of obesity in relation to land use mix

•Smith et al (2008) tracked the body mass index of nearly half a million residents of Salt Lake County, Utah, in relation to the average age of neighborhood housing; and the proportion of residents who walked to work. •Residents in neighborhoods built before 1950 walked more. •Men living in walkable neighborhoods weighed 10 pounds less than men living in less walkable neighborhood. The average woman weighed six pounds less.

Walkability & Body Mass Index

Ken R. Smith, Barbara B. Brown, Ikuho Yamada, Lori Kowaleski-Jones, Cathleen D. Zick, Jessie X. Fan, “Walkability and Body Mass Index Density, Design, and New Diversity Measures,” American Journal of Preventive Medicine, Volume 35, Issue 3, September 2008, Pages 237-244

Image, Kate Glicksberg ,The New York Times, July 31, 2008, “This Old (Healthy) House,” Tara Parker-Pope

http://well.blogs.nytimes.com/2008/07/31/this-old-healthy-house/

Archival data on universe of 2857 public school children living in East Little Havana

Mixed-Use

José Szapocznik, Joanna Lombard, Frank Martinez, Craig A. Mason, Deborah Gorman-Smith, Elizabeth Plater-Zyberk · Scott C. Brown, Arnold Spokane, “The Impact of the Built Environment on Children’s School Conduct Grades: The Role of Diversity of Use in a Hispanic Neighborhood,” American Journal of Community Psychology, Volume 38, Numbers 3-4 / December, 2006: 299-310.

Mixed Use & Conduct Grades- ELH • A child living in a Residential block was

1.74 times more likely to have conduct grades in the lowest 10% than a child living in Mixed Use blocks.

• 38% of the cases where youth were in the lowest 10% of conduct grades are associated with the specific risk of living in a Residential block, above and beyond the risks associated with living in a Mixed Use block.

José Szapocznik, Joanna Lombard, Frank Martinez, Craig A. Mason, Deborah Gorman-Smith, Elizabeth Plater-Zyberk · Scott C. Brown, Arnold Spokane, “The Impact of the Built Environment on Children’s School Conduct Grades: The Role of Diversity of Use in a Hispanic Neighborhood,” American Journal of Community Psychology, Volume 38, Numbers 3-4 / December, 2006: 299-310.

Physical Activity & Health Investigators reported that their most significant finding was that fitness increased with even minimal levels of activity. Moving from being totally sedentary to an activity level of approximately 72.2 minutes per week—a little over 10 minutes per day—resulted in improved cardiorespiratory fitness. These shifts in activity level can surely be achieved through walking programs and other small changes in activity behaviors among the sedentary. Prior research has confirmed an inverse association between cardiorespiratory fitness and the development of cardiovascular disease risk factors in young and middle-aged adults.Fitness is inversely associated with cardiovascular and total mortality in men and women across the life span.

Mercedes R. Carnethon, “Physical Activity and Cardiovascular Disease: How Much Is Enough?” American Journal of Lifestyle Medicine, Vol. 3, No. 1 Suppl, 44S-49S (2009)

http://www.bta4bikes.org/at_work/walknbikecmte.php

Built Environment & Hypertension

Residents of sprawling counties were more likely to walk less, weigh more, and have hypertension than residents of compact counties. Difference in weight between least and most sprawling counties was 6.3 lb

Reid Ewing, Tom Schmid, Richard Killingsworth, Amy Zlot, Stephen Raudenbush, “Relationship Between Urban Sprawl and Physical Activity, Obesity, and Morbidity,” American Journal of Health Promotion, Sept/Oct 2003: Vol. 18 Issue 1:47-57.

Sprawl Index • Residential density was defined in terms of gross and net densities and proportions of population living at different densities; seven variables made up the metropolitan density factor. • Land use mix was defined in terms of the degree to which land uses are mixed and balanced within subareas of the region; six variables made up this factor. • Degree of centering was defined as the extent to which development is focused on the region's core and regional subcenters; six variables made up this factor. • Street accessibility was defined in terms of the length and size of blocks; three variables made up this factor.

Built Environment & Chronic Conditions

Roland Sturm*, D.A. Cohen, "Suburban Sprawl and Physical and Mental Health", Public Health, 118(7), 2004:488-496.

Sprawl significantly predicts chronic medical conditions and health-related quality of life-

An increase in sprawl from one standard deviation less to one standard deviation more than average implies 96 more chronic medical problems per 1000 residents, which is approximately similar to an aging of the population of 4 years.

8686 participants in 38 US metropolitan areas

Χ2(121) = 161.283, p = .008 Χ2/df = 1.333 CFI = .95 RMSEA = .035

*Controls for age, gender, and income

Built Environment & Physical Functioning PRE-BASELINE BASELINE 12 MONTHS 24 MONTHS (2000-2002)

PHYSICAL FUNCTIONING*

-.17

-.18

.22

.19

SOCIAL SUPPORT

-.55

FRONT ENTRANCE

-.24

PSYCHOLOGICAL DISTRESS*

-.32

Above Grade

Stoop

Porch

Window Area

Low Sill

Grd. Parking

Small Setback Elders who lived in blocks with few positive front-entrance-features were 2.7 times as likely to have

poor physical functioning, compared to elders residing on blocks with greater numbers of positive

front-entrance qualities. Scott C. Brown, Craig A. Mason, Tatiana Perrino, Joanna L. Lombard, Frank Martinez,1Elizabeth Plater-Zyberk, Arnold R. Spokane, José Szapocznik, Built Environment and Physical Functioning in Hispanic Elders: The Role of "Eyes on the Street,“ Environmental Health Perspectives ,Volume 116, Number 10, October 2008:1300-07.

Built Environment & Physical Activity

Committee on Physical Activity, Health, Transportation, and Land Use, Does The Built Environment Influence Physical Activity? Examining The Evidence,

Transportation Research Board Institute of Medicine of The National Academies, Transportation Research Board Special Report 282, National

Academy of Sciences, 2005. http://onlinepubs.trb.org/onlinepubs/sr/sr282.pdf

Regular physical activity is important for health, and inadequate physical activity is a major, largely preventable public health problem. Built environments that facilitate more active lifestyles and reduce barriers to physical activity are desirable because of the positive relationship between physical activity and health. (8)